Failure to Monitor and Document Bowel Movements Leads to Fecal Impaction
Penalty
Summary
Facility staff failed to monitor and document bowel movements for two residents, both of whom were assessed as being at risk for constipation and dehydration. The facility's policy required staff to determine daily if residents had a bowel movement, document this information, and notify the charge nurse if a resident had not had a bowel movement in three days. For one resident with impaired cognition and a history of opiate use, staff did not document any bowel movements for over a week, nor did they administer prescribed as-needed laxatives. This resident was ultimately sent to the hospital and diagnosed with fecal impaction. For the second resident, who also had a diagnosis of constipation and was prescribed multiple medications with constipating side effects, staff failed to document bowel movements for several extended periods, including gaps of seven, eight, and eleven days. There was no documentation that as-needed laxatives were administered during these times. Interviews with staff revealed a lack of awareness regarding the residents' bowel movement status and inconsistent monitoring and documentation practices. Staff interviews confirmed that CNAs were responsible for documenting bowel movements each shift and notifying licensed staff if a resident had not had a bowel movement in three days. However, both CNAs and licensed staff were unaware of the prolonged periods without bowel movements for the affected residents, and there was no evidence that appropriate interventions were implemented as required by facility policy and physician orders.